Year 2023 / Volume 115 / Number 1
Letter
Encephalopathy in short bowel syndrome: a diagnostic challenge

47

DOI: 10.17235/reed.2022.8826/2022

Gorka Martínez Navarro, Begoña Polo, Ester Donat, Etna Masip, Joan Pacheco, Ana Adell, Pedro Ortega, Carmen Ribes-Koninckx,

Abstract
A 15-year-old boy was admitted to the hospital due to ataxia, drowsiness and bradypsychia. He was known to have a short bowel syndrome Initial venous blood gases revealed a metabolic acidosis with a high anion gap of 24 mmol/L and normal L-lactate. He improved with fasting and fluids and was discharged with oral metronidazole. 2 weeks later he was admitted again with similar symptoms. A specific study of D-Lactic acidosis was carried out, confirming the diagnosis. D-lactic acidosis is an uncommon complication of short bowel syndrome. It occurs as a consequence of the metabolism of unabsorbed carbohydrates. The symptoms are mainly neurological. Limiting the dietary carbohydrates is useful to avoid recurrences. Poorly absorbable antibiotics are used but with varying results. Surgery may be an option if medical treatment fails. Probiotics might be useful to avoid symthoms recurrence.
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References
Kowlgi N, Chhabra L. D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome. 2022. 10.1155/2015/476215
Yilmaz B, Schibli S, Macpherson A, Sokollik C. D-lactic Acidosis: Successful Suppression of D-lactate–Producing Lactobacillus by Probiotics. Pediatrics. 2018;142(3).
Jansson-Nettelbladt E, Meurling S, Petrini B, Sjölin J. Endogenous ethanol fermentation in a child with short bowel syndrome. Acta Paediatrica. 2006;95(4):502-504.
Lallas M, Desai J. Wernicke encephalopathy in children and adolescents. World J Pediatr 2014;10:293-8.
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Martínez Navarro G, Polo B, Donat E, Masip E, Pacheco J, Adell A, et all. Encephalopathy in short bowel syndrome: a diagnostic challenge. 8826/2022


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Publication history

Received: 29/03/2022

Accepted: 01/06/2022

Online First: 15/06/2022

Published: 12/01/2023

Article Online First time: 78 days

Article editing time: 289 days


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